Study finds link between heart failure and kidney disease

Researchers from Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, have found links between heart failure and kidney disease that could support new approaches for integrating the care of these conditions.

The results were published in JAMA Cardiology.

About two-thirds of older adults with heart failure have abnormal kidney function. However, few analyses to date have investigated the occurrence of clinically relevant kidney outcomes, such as hospitalization for acute kidney injury or dialysis, in patients with heart failure. Evaluating these more recognizable and patient-centered outcomes may result in substantial changes to the way that heart and kidney disease are managed together in the clinic.

The study examined Medicare claims data from 85,298 patients over 65 who were hospitalized with heart failure between 2021 and 2024, using data from the Guidelines-Heart Failure Registry.

Researchers found that 63 percent of these patients were discharged with significantly impaired kidney function, measured by their filtration rate.

They also discovered that patients with lower kidney function had a much higher risk of adverse kidney outcomes. One year after discharge, 6 percent of patients were on dialysis, and 7 percent were either on dialysis or had progressed to end-stage kidney disease.

The findings suggested that cardiologists should prioritize assessing kidney function – including measuring kidney filtration and looking for evidence of protein in the urine, also known as albuminuria – in all patients with heart failure.

More broadly, the study emphasized the need for systemic changes that better support the simultaneous management of heart and kidney disease, including establishing clinics focused on integrating these two care areas, and incorporating kidney outcomes into health care performance metrics for cardiovascular diseases.

“We know that heart and kidney health are highly interconnected, but management of heart and kidney disease remains relatively siloed, and kidney health often isn’t prioritized in patients with heart disease until advanced stages. Declining kidney function is often asymptomatic until late in the disease course, but even less advanced stages of kidney impairment can have important implications for cardiovascular health. Hence, there’s a need for analyses that assess kidney outcomes in people with heart failure,” said first author John Ostrominski, MD, a fellow in Cardiovascular Medicine and Obesity Medicine at the Brigham.

Reference: Ostrominski JW, Greene SJ, Patel RB, et al. Kidney Outcomes Among Medicare Beneficiaries After Hospitalization for Heart Failure. JAMA Cardiol. Published online May 29, 2024. doi:10.1001/jamacardio.2024.1108